Healthcare Provider Details

I. General information

NPI: 1730482928
Provider Name (Legal Business Name): RICHARD HEBREZA CLEMENTE ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FIRST AVENUE, HCC 13 NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016-1753
US

IV. Provider business mailing address

2145 44TH DR APT 1B
LONG ISLAND CITY NY
11101-4750
US

V. Phone/Fax

Practice location:
  • Phone: 347-346-2560
  • Fax:
Mailing address:
  • Phone: 917-456-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number520383
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430528-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: